What is the typical starting dose and administration schedule for Novolog (insulin aspart protamine/insulin aspart) 70/30 in patients requiring insulin therapy?

Novolog 70/30 Dosing Protocol

The typical starting dose for Novolog 70/30 (insulin aspart protamine/insulin aspart) is 10 units twice daily or 0.1-0.2 units/kg per day, administered 30 minutes before breakfast and dinner. 1

Initial Dosing

• Start with 10 units or 0.1-0.2 units/kg of body weight per day, divided into two equal doses 2, 1
• Administer twice daily, 30 minutes before breakfast and dinner 1
• For insulin-naïve patients, this starting dose is generally safe and effective 3
• When transitioning from oral agents to insulin therapy, continuing metformin with Novolog 70/30 can provide better glycemic control 3, 4

Dose Titration

• Set fasting plasma glucose (FPG) target (typically 90-150 mg/dL) 1
• Increase dose by 2 units every 3 days if 50% of fasting glucose readings are above target 2, 1
• Decrease dose by 10-20% if hypoglycemia occurs 2
• Evaluate glycemic control every 2 weeks and adjust therapy as needed 1

Administration Schedule

• Administer twice daily, with morning and evening doses 2, 1
• Morning dose: 30 minutes before breakfast 1
• Evening dose: 30 minutes before dinner 1
• The fixed ratio (70% protamine-crystallized insulin aspart, 30% soluble insulin aspart) addresses both basal and prandial insulin needs 5

Monitoring

• Regular self-monitoring of blood glucose is essential for dose adjustments 1
• Monitor for hypoglycemia, which is the most common adverse effect 1
• Assess both fasting and postprandial glucose levels to evaluate efficacy 5
• Studies show that premixed insulin analogues like Novolog 70/30 provide better postprandial glucose control than human insulin 70/30 5, 6

Special Considerations

• For patients receiving enteral bolus feedings, approximately 1 unit of insulin per 10-15g carbohydrate should be given before each feeding 2
• For patients on glucocorticoid therapy, higher doses may be needed, particularly for daytime hyperglycemia 2
• When transitioning from basal insulin, the total daily dose can be divided into two equal doses of Novolog 70/30 2

Treatment Intensification

• If glycemic targets are not achieved with twice-daily dosing, consider:
  • Advancing to three-times-daily premixed insulin 1
  • Switching to a basal-bolus regimen 2, 1
  • Adding a GLP-1 receptor agonist if appropriate 2, 1

Common Pitfalls

• The fixed ratio (70/30) offers less flexibility compared to separate basal and bolus insulins 1
• May not be optimal for patients with highly variable insulin requirements throughout the day 1
• Avoid using rapid-acting insulin at bedtime to prevent nocturnal hypoglycemia 1
• Patients may experience weight gain, though this is often less than expected given the improvement in glycemic control 4

Studies have shown that patients using Novolog 70/30 can achieve significant reductions in HbA1c (1.1-1.3%) with once-daily dosing when combined with metformin, and even greater reductions with twice-daily dosing 3, 4. A comparative study demonstrated that a 70/30 insulin algorithm provided superior glycemic control compared to traditional sliding scale insulin dosing 7.